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NSW Midwives Conference

Sex Discrimination

The Truly Oldest Profession: Facing
Future Challenges

Speech by Federal Sex Discrimination
Commissioner Pru Goward at the NSW Midwives Conference, 25
July 2003.

  • Thank you Hannah for
    inviting me to speak to you today.
  • I would like to begin
    by acknowledging the traditional owners of the land, the Eora people and all
    the wonderful women here who regularly partake in the miracle of delivering
    life.
  • It must be a source
    of great pride to midwives to consider you are part of a profession that reaches
    back thousands of years and across all cultures, that has seen its members
    reviled and murdered as witches and revered as saints.
  • Certainly the patience
    of a saint and the powers of a witch are needed today with the challenges
    before this ancient and honourable profession.
  • I understand from your
    association that the difficulty of accessing professional indemnity insurance
    is now driving people from your profession as it is from doctoring.
  • It is disappointing
    that governments have not seen fit to assist midwives with insurance in the
    same way they have with doctors, but sadly that is entirely consistent with
    the public-life view of women’s work.
  • Whether it be mothering,
    cleaning, caring for other people’s children or serving them food, traditional
    women’s work has never been much valued in the world of work.
  • After all, women’s
    work is just what women do- there is a strong belief that if women do it well
    it is not because of any skill and dedication, it’s just the way women
    are. No need to reward it, it comes with the package anyway, it is genetic.
  • A quick glance at the
    list of issues confronting you and the facts surrounding them (such as the
    low numbers of midwives and the lack of indemnity insurance) suggests that
    the Association certainly has its lobbying work cut out for it.
  • The New Zealand decision
    to allow universal access to midwifery from 1990 looks like a good starting
    point in making the case for similar change here, but is not an area in which
    I would venture an opinion.
  • Today I would like to
    address two issues of concern to both of us:
  • The shortage of midwives
    and the rising number of maternal deaths. I am unable and unwilling to make
    a direct link between these two outcomes but each of them is of concern in
    its own right.
  • Let me begin with maternal
    deaths. I have drawn my material largely from the authoritative 1994-6 Report
    on Maternal Deaths in Australia, the most recent triennial report available.
  • The report is compiled
    by a distinguished panel of professionals and relies on well respected data
    bases, including the State and Territories Confidential Death Enquiries.
  • It goes without saying
    that the maternal death rate in Australia is low, 13 per one hundred thousand
    births. It is low by international standards, although only in the middle
    of the range for developed countries.
  • We are comparable to
    Japan, NZ, western and northern Europe and USA - around 10 (direct deaths)
    per 100,000 (live births). Ratios in southern and eastern Europe slightly
    higher at about 30 deaths per 100,000 live births. Australia ranked 9th in
    1990. Indonesia has the highest rate, Canada, Norway and Switzerland the lowest.
  • What is troubling today
    is that the maternal death rate in Australia has risen. 13 deaths per 100,000
    confinements is an increase. That is according to the last report from the
    NHMRC, 1994-96, the latest period for which authoritative data is available.
  • We are still awaiting
    the report of the most recent triennial, and I have to say it seems to be
    very slow in coming. I understood there was some talk of discontinuing with
    the report but the NHMRC has advised me that the 1997-1999 Report will be
    available next year.
  • But we all know the
    difference between mortality and morbidity. Mortality is death, morbidity
    is ill-health. Epidemiologists link them closely. Where ever there is a climbing
    mortality rate, you can be sure there is an increasing morbidity rate and
    inevitably morbidity is more prevalent in any given population.
  • So, for example, with
    every percent increase in the maternal mortality rate, you can expect to find
    an increase in the numbers of punctured bladders, torn or permanently damaged
    anal muscles, incontinent bladders and uteri, and so on.
  • So it is foolish to
    pat ourselves on the back and say that a rate of 13 deaths per hundred thousand
    confinements is nothing to worry about. It means tragedy for the one hundred
    women who died and their families who mourn, any increase in maternal death
    rates is disturbing and also suggests an underlying increase in the morbidity
    rate which affects far more women
  • It is particularly alarming
    to think it is going up in an age of improved medical and surgical care
  • The obvious points about
    the causes of the increasing death rate are made in the Report- increasing
    maternal age is a factor, with mothers over the age of thirty five being the
    fast growing age group of mothers.
  • The authors also point
    out that women with complex medical conditions believing modern medicine will
    save them are now more willing to take the risk on a pregnancy, some with
    tragic results.
  • Surely maternal age
    is something we can address? Australia does not have a good record in facing
    up to issues surrounding sexuality; we have a high teenage abortion rate and
    now a high infertility rate among older women, many of whom are shocked to
    discover that their age has betrayed them without their knowledge. The truth
    is we don’t discuss the higher risks facing women who delay child birth,
    such as the risks of death and the risks of not being able to bear a child.
  • Interestingly, the Report
    finds that once age is standardised the death rate among older mothers (over
    forty) has actually declined since 1973 while the age standardised death rate
    for women aged 30 -34 has risen alarmingly.
  • This age group now has
    the highest standardised maternal death rate. It is also the age group most
    likely now to begin having children. This suggests to me that women over forty
    take their maternal health very seriously (as do their doctors or midwives)
    but that women in their early thirties are more likely not to consider their
    age a problem.
  • When you think women’s
    fertility begins to decline from the age of 27, perhaps we should assume there
    will be broader health implications by the time they are in their early thirties.
  • The high incidence of
    mothers, especially first time mothers, in paid work during their pregnancy
    may also impact on health outcomes. Busy women are more likely not to see
    a doctor early on, or regularly, if they are working.
  • I did not work while
    bearing either of my first two children, and spent many a happy hour reading
    magazines in the doctor’s surgery, waiting to be told how I was doing
    and to report any little problems.
  • Even when pregnant with
    my last child, I lived in Canberra, a city that made it possible for me to
    fit a weekly visit to the obstetrician in around my busy schedule as a radio
    presenter for the last month of the pregnancy.
  • You can be sure however,
    that many young women today just can’t get there that often. The forty
    minute bus trip across town during a lunch hour is just not on for most young
    working expectant mothers.
  • It would be no bad thing
    if the NSW Midwives Association made it their business to lobby government
    to begin public awareness campaigns about the importance of early prenatal
    care, of on-going prenatal care and of risk factors associated with maternity
    such as ageing mother hood.
  • A final reference to
    the Triennial Report.
  • “Avoidable factors”.
    Accidents. Errors. Of the one hundred deaths, one occurred with a midwife.
    The others occurred in hospital-medical settings.
  • But the Report found
    “avoidable factors” (such a euphemism) were possibly or certainly
    present in 48 per cent of deaths directly the result of giving birth, and
    20 per cent of indirect deaths. This is a doubling in the percentage of avoidable
    factor- deaths since the previous report.
  • The patient was responsible
    for the avoidable factor in two cases, most were doctor and or hospital or
    doctor. Only one death involved a doctor and patient avoidable factor. I infer
    from the Report that avoidable factors were not involved in the death where
    a midwife was present.
  • As a consequence, the
    Report called for greater scrutiny and surveillance of maternal deaths but
    if it’s happened it certainly isn’t public.
  • Again, a worthy cause
    for the Midwives Association to take up
  • Let me turn now to the
    shortage of midwives. I understand there is a shortfall of almost two thousand
    midwives in Australia. With the average age of nurses now well into their
    forties, we have a situation where more people are leaving than entering this
    profession.
  • The good news, if we
    want to be very black-humoured, is that Australia’s birth rate is so
    woeful, and projected to fall further, we will need fewer midwives.
  • There is no doubt midwives
    get bad press. Stories of midwives bungling deliveries and facing litigation
    from heart broken parents abound, undoubtedly discouraging mid wife use.
  • The facts need to be
    put on the table- and advertised- if you, the midwives, want that to change.
    I leave that as a challenge for you. It is in the interests of all of us that
    this issue is put to rest and who better than this association to take up
    the debate.
  • It is reminiscent of
    an earlier battle your predecessors fought and lost; the mediaeval battle
    between church and witches (who were really female doctors and midwives).
  • This battle to the
    death, which began in 1484 with a papal bull condemning all practices of diabolic
    art and led to the deaths of thousands of women by fire or drowning, was not
    really about the use of magic and supernatural evil, but about who had power
    over life and death, men or women, and who collected the money.
  • We must ensure that
    this time the battle is not won or lost without a good fight about the facts.
  • The declining numbers
    taking up nursing careers- and midwifery- is undoubtedly the result of many
    social and economic changes.
  • A greater range of education
    and career choices for women, low wage rates associated with midwifery, the
    terrible work hours associated with child birth and the consequent difficulty
    in juggling work and family commitments plus the increasing risk of litigation,
    all discourage young women from entering the profession or staying in it.
  • While midwives working
    in hospitals may have better access to family friendly provisions, it is clear
    that those engaged in health centres or as home birth midwives work under
    very different conditions.
  • Paid maternity leave
    has long been standard for nurses in public and most private hospitals; not
    so outside. Interestingly, there is quite strong evidence that a period of
    paid leave after the birth of a child is associated with a reduction in infant
    mortality rates.
  • It has to be added that
    there is not much of a relationship between paid leave and low birth weight
    and only a very small reduction in neonatal mortality.
  • Child birth deaths are
    not related to paid leave- and if almost half our child-birth deaths are the
    result of errors, then that’s exactly what we could expect.
  • But according to an
    American study of European countries offering paid leave, a 10 per cent decrease
    in women employed is associated with a 5.5 per cent decrease in post neonatal
    mortality.
  • Post neonatal babies
    are those between a month and a year old. In other words helping mothers to
    stay home with their babies is better for the baby’s prospects as well
    as the mother’s recovery.
  • Health economist Christopher
    Rhum from the University of North Carolina, who did the study, estimates a
    10-week increase in paid leave reduces infant mortality rates by between 2.5
    per cent and 3.4 per cent. A lot of this is due to breast feeding but the
    high level of attentiveness mothers give their babies is clearly also important.
  • Child fatalities go
    down by between 3.3-3.5 per cent with an extra ten weeks of paid leave. Again,
    you can expect the morbidity effects to be even greater.
  • Yet despite this- and
    an overwhelming body of other evidence to suggest the health and welfare benefits
    to Australian families would be enormous- Australia remains one of only two
    OECD countries in the world without a nationally mandated scheme.
  • No wonder countries
    like Canada, where they offer 50 weeks of paid leave at 55 per cent of earnings,
    are poaching our nurses and teachers and anyone else they can get their hands
    on.
  • Forty thousand Australians
    left Australia last year- the highest number ever- and if we want them to
    come back here when it is time for them to start their families, we need to
    see we are in competition with other countries that welcome working parenthood
    and support it.
  • My proposal for paid
    maternity leave, which I submitted to the Government last December, proposed
    a government funded scheme for women who had been in paid work for 40 of the
    past 52 weeks.
  • They could be part time,
    casual, full time, self employed, bosses or contract workers. They just have
    to have worked regularly enough to demonstrate a reliance on income.
  • Eligible women would
    receive up to the minimum wage for a period up to 14 weeks. They would not
    be eligible for some other government benefits during that period, nor the
    Maternity Allowance nor the first twelve months of the Baby Bonus. If they
    went back to work before that, they did not receive the benefit.
  • The net cost of the
    scheme was estimated to be $213million a year. Cheaper than any other family
    support programme, including the maternity allowance. Certainly very affordable
    and modest, hardly a burden for the Australian tax payer, especially when
    compared with the $17 billion the Australian Government currently spends supporting
    our families.
  • Never let it be said
    that having a child is a personal choice and tax payers need not be involved.
    Australian tax payers have been involved since the introduction of the first
    maternity benefit in 1912- a benefit paid to married and unmarried mothers.
    We support families to ensure all our children get a decent start.
  • Paid maternity leave
    is no different- it ensures all Australian children get off to a decent start,
    meaning they are able to be breast fed, to feel loved and needed, to have
    their developmental needs supported and enhanced by the full time love and
    care of a parent.
  • Midwives, like other
    Australian women, are caught up in the nightmare of combining work and family.
    While 57 per cent of mothers work part time, 43 per cent work full time.
  • Forty three percent
    of mothers do the crazy mother juggle five days a week. The other 57 per cent
    do it two or three days a week. The so called very flexible family friendly
    workers- some might say they are the lucky ones- who work shorter hours each
    day are the casuals and part timers least likely to enjoy paid leave entitlements
    like paid maternity leave or sick leave.
  • The Australian Institute
    of Family Studies estimates that 40 per cent of Australian mothers work without
    access to paid benefits, including paid maternity leave.
  • In fact it comes as
    something as a shock to people to discover that Australia is the sort of place
    that gives you paid sick leave if you break your leg playing football on Saturday
    and need time off work but doesn’t give you a day’s paid leave
    if you have a Caesarian section.
  • Perhaps there are also
    some contradictions in a so called family friendly country like Australia
    paying child care subsidies to women who return to work and leave their child
    in someone else’s care but nothing to the woman who wants to do the
    caring herself for the first three months.
  • With an ageing society
    of course, it is not just children women are looking after. Ageing relatives
    also have demands.
  • With the determined
    reduction in the numbers in institutionalised care, it is increasingly families
    who are caring for parents post operatively, sorting out dad’s phone
    bill, taking mum shopping and doing their washing. That mostly means women
    doing the caring.
  • I sometimes wonder how
    women have time to work- they do ¾ of the unpaid child care and 2/3
    of housework.
  • Working mothers sleep
    less than others and spend even less time on personal grooming than men do.
  • It is no wonder that
    the Australian birth rate has dropped to 1.73 children on average, per woman.
    That old saying that if men had babies there might be a first child but there
    wouldn’t be a second is now proving true for women too.
  • The enormous difficulties
    women encounter should they wish to combine work and family means many really
    don’t want to do it a second time. Perhaps this explains why the birth
    rate has dropped.
  • While there are more
    women ending their lives without having children at all, women also have fewer
    children. The number of only-child families has risen from one in five families
    in 1980 to one in three families today.
  • There are primary schools
    in Melbourne and Sydney where half the class is made up of only children.
    It’s also clear, listening to women describe their decision-making,
    that return to work is a big issue.
  • Most women want as much
    time off work as possible, but it needs to be paid. Couples save up for babies.
    They save up her annual leave for a couple of years, they pay the mortgage
    off in advance, they stop going on holidays or out for a meal.
  • With all that, they
    can afford to take maybe six months off work. If they have employers who offer
    paid maternity leave, they will take longer.
  • A recent Queensland
    survey showed that one in three women who took maternity leave was back at
    work by the time the baby was six months old. Since no more than 40 per cent
    of mothers in the workforce have access to paid maternity leave, this is understandable.
  • Now a family will do
    that the first time, for the first child. But there just aren’t the
    resources and time squirreling possibilities there to do it again, for the
    second child. So increasingly they don’t.
  • We have made the choice
    of having children just too hard for all but the unemployed, the wealthy and
    the very children-committed. I suspect if that had been the reality during
    our parents’ day, many of us would not be here today.
  • It should not be that
    people have to be very poor or very rich or are especially keen on having
    children in order to do so.
  • We are not alone. All
    OECD countries are dealing with birth rates below replacement level. Only
    the United States and ourselves do not have pro natal policies to address
    this. Only the United States and ourselves do not have paid maternity leave.
  • Some countries, like
    France, believe the increase in their birth rate is the result of family friendly
    policies like six months paid maternity leave. The Scandinavian countries
    certainly enjoy higher birth rates than those parts of Europe without family-friendly
    work policies.
  • Paid maternity leave
    alone cannot fix the problem, although there is some evidence in America that
    women in companies which offer paid maternity leave have slightly higher fertility
    rates than those working in companies who do not.
  • But there is no country
    in the world trying to address its fertility problem, including traditional
    family values countries like Portugal, which got down to a birth rate of 1.1
    children per woman, that does not include paid maternity leave in its suite
    of measures. For the obvious reason that women will be reluctant to have children
    if they cannot afford to stay home to recover from the birth.
  • Most people don’t
    take three months off to have a holiday without using paid leave either, and
    child rearing is no holiday!
  • There has been a strong
    moralistic dimension to the debate about paid maternity leave to which I have
    objected. It was not a moral objection raised by the Churches- both the Catholic
    Archbishop of Sydney, George Pell, and the head of the Central Mission, Gordon
    Moyes, support paid maternity leave, but there was the view that it was immoral
    for women to work with children and that paid maternity leave would reward
    this immorality- that somehow it would make them go back to work and legitimise
    their sin.
  • This ignores the fact
    that existing industrial paid maternity leave arrangements do exactly that-
    almost always the woman has to return to work before she receives the balance
    of the leave monies owing, often forcing her back to work earlier than she
    would have liked.
  • Upon reflection, I
    too believe there is a moral dimension to the paid maternity leave debate.
    I believe it is immoral to turn our backs on women and babies at the most
    vulnerable stages of their lives and tolerate a situation where all our bar
    maids and hotel workers are estimated to be back at work within three months,
    where half our car factory and assembly line workers come back to work as
    soon as their six weeks leave are up, and where the number of women returning
    to work within a year of the birth grows every year.
  • The proportion of mothers
    of children under one in paid work has doubled from 17 per cent in 1976 to
    36 per cent in 2001 (the space of a single generation).
  • That is immoral. And
    it is no longer happening in other western countries.
  • Women have come as far
    as they can alone. The super mum syndrome is as prevalent today as it has
    been since mothers began to stay in the workforce and the pay gap has hit
    a ceiling at 85 cents in the male dollar for those in full time work. If we
    include part time and casual workers, the gender pay gap stretches to 63 cents
    in the male dollar. We have hit a ceiling.
  • Until we get more men-
    and in particular more fathers- engaged in equal sharing of family responsibilities,
    female-dominated professions like midwifery will struggle to retain skilled
    and experienced workers.
  • Women will continue
    to enter and leave the workforce at great expense to employers and the economy.
    All that investment in the education and training of young women will be seen
    as less productive than investment in the education and training of young
    men.
  • So how do we do it?
  • Practical change one
    – the introduction of paid parental leave. While we recommended the
    first fourteen weeks of paid leave be maternity leave only, and available
    to non birth parents only in very limited circumstances, any longer period
    of paid leave should be shared between parents.
  • This is the standard
    practice across Europe.
  • In Denmark for example
    28 weeks of paid maternity leave is provided to mothers, the last 10 of which
    may be taken by the father.
  • Turning to more long
    term measures - flexible working arrangements, including part time work should
    be available to all parents.
  • It can be argued that
    currently they are. The year of unpaid parental leave is available to either
    mothers or fathers.
  • In theory there is nothing
    stopping men from accessing part time working arrangements or flexible work
    hours.
  • In reality, we do not
    live in a society which tolerates or venerates men who do part time work or
    leave work early to pick up a sick child from school.
  • Our culture is such
    that these men are more likely to be seen as uncommitted to their careers
    to an even greater extent than women who allow their family life to intrude
    into their working life.
  • The tariff for being
    involved in the unpaid caring work of their families is very high for men.
  • So most of them don’t
    do it.
  • And as long as men continue
    to earn more than women it usually makes more sense for the women to change
    her paid work arrangements to factor in child care.
  • The discrimination is
    self perpetuating.
  • The reality is then
    that we can implement as many ‘family’ friendly practices or policies
    as we like, however unless they are coupled with a genuine attitude that either
    parent can access these measures they will be for ‘women only’.
  • Averting the work/life
    balance collision and replacing it with a genuine work life is both the key
    issue and key challenge facing women today. It is also the key issue and challenge
    facing men and the workforce overall.
  • The time has come for
    us to see this challenge in this holistic manner. It is the only way we will
    ever achieve more progress, bridge that remaining gender pay gap.
  • It is the only way there
    will be equality of choice for men and women.
  • Thankyou

Last
updated 25 August 2003.